You Want Me To Massage My What….?
Yep, you read correctly… this post is a bit intimate and personal, but nevertheless extremely important for women, especially first-time mums.
There has been a great deal of research to demonstrate the benefits antenatal perineal massage.
A recent study by Ugwu et al. (2018) found that antenatal perineal massage reduced the need for episiotomy and ensured that the perineum remained intact after delivery as well as implications for reduced post-natal incontinence. Shahoei et al (2017) found that when the perineum was massaged during the second stage of labour the need for episiotomy was reduced in addition to injury and pain.
And while perineal massage is not something that a massage therapist will perform on a client, it is something that you can do, within the privacy of your own home, alone or with your partners help.
So, What is Perineal Massage?
Perineal massage helps to increase the stretchiness and flexibility of the perineum by stretching the skin of the birth outlet and helping you to prepare you for the sensations of tingling, burning or stinging as your baby’s head is born. The massage can be performed by you or your partner to stretch the perineum by rubbing the area with fingers or thumbs. It may reduce your risk of having a tear or needing an episiotomy post-partum.
And Where is the Perineum?
The perineum is the area of skin between the vagina and the anus. During a vaginal childbirth, this area stretches to allow your baby to be born. Particularly with your first birth, this area gets stretched as the head is being born and may tear a little as the head comes out. Performing perineal massage on yourself towards the end of your pregnancy can help prevent this from happening.
Studies have shown that perineal massage can reduce tearing at birth for women having their first baby, ensure you are more comfortable and recover more quickly following the birth, help you enhance the bond with your baby better and are able to care for them more easily.
When should I not perform perineal massage?
Perineal massage should not be performed:
- Before 34 weeks of pregnancy
- If you have a low lying placenta (placenta praevia)
- If you have genital herpes, thrush or other vaginal infection, which may spread to other areas
- If you or your partner has an open wound or infection on the hands or fingers
When should I start?
It is recommended that perineal massage starts between 34-35 weeks of your pregnancy. It can be done once a day. Initially you may experience a strong stretching or burning sensation but over time you may start to notice a change in the flexibility and stretchiness of the skin and these feelings should decrease.
Before starting perineal massage, you should:
- Empty your bladder
- Wash your hands
- Find a relaxing place to perform perineal massage, such as your bathroom, bedroom or anywhere else you feel comfortable.
- Sit or lean back. It may help to prop your hips comfortably with a pillow
- A warm bath or warm compress on the perineum for 10 minutes before may help with relaxation
- Using a mirror for the first few times will help you to become familiar with the area you are massaging
- You can do the massage yourself, but you may find it easier for your partner to do it
- Use lubrication– this can be olive, wheat germ or almond oil or vitamin e cream
How to perform the perineal massage
- Put the lubricant on your thumbs and around the perineum
- Place your thumbs just inside the vagina, about 3-4 cm in depth
- Press downward and to the sides at the same time, stretching your vagina open as wide as possible until you feel a tingling or burning sensation. Pause and take a deep breath
- Keeping a steady pressure move your thumbs from side to side in a ‘u’ shaped motion. The area may become a little numb and you won’t feel the tingling as much
- Hold the stretch for 45-60 seconds and then release
- Massage with more oil and stretch again to maximum hold then release. Do this daily for about 5– 10 minutes
At first your perineum will feel tight but as you practice the tissues will relax and stretch. Focus on relaxed breathing, relaxing the pelvic floor muscles and allowing the tissues to stretch.
If your partner is helping you do perineal massage – ensure they use clean hands and either their thumbs or one to two index fingers inside the lower part of the vagina. It is important to tell your partner how much pressure to apply without causing too much discomfort or pain.
Ugwu EO, Iferikigwe ES, Obi SN, Eleje G, Ozumba BC, 2018. Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial. The journal of Obstetrics and Gynaecology Research.
Shahoei R, Zaheri F, Nasab LH, Ranaei F 2017. The effect of perineal massage during the second stage of birth on nulliparous women perineal: A randomization clinical trial. Electronic Physician.